St. John River District Hospital n East China Townshi is moving toward more of an outpatient services model.

St. John River District Hospital in East China Township has closed its intensive care unit and cut more than 30 full-time equivalent employees, Crain's has learned.

Gwen MacKenzie, Ascension's Michigan market leader, confirmed Thursday the changes, primarily driven by a low census of 12-14 patients per day at the hospital and the movement from inpatient to outpatient care volume.

MacKenzie said River District also has closed 52 of 68 staffed beds. The hospital will staff 12 medical-surgical beds and four observation beds.

Over the next 18 months, Ascension plans to build an outpatient medical center nearby the hospital in St. Clair County. The health system is looking for suitable property, she said.

Since last month, Crain's has reported dozens of layoffs of nurses, medical therapists and technicians, unit clerks and other support service employees at Ascension's 14 hospitals in Michigan. Layoffs of hospital union workers are expected to be announced over the next several weeks.

In Michigan, Ascension has laid off workers at St. John Hospital and Medical Center in Detroit, Providence-Providence Park hospitals in Southfield and Novi, St. John Macomb-Oakland Hospital in Plymouth and Warren, and Borgess Medical Center in Kalamazoo.

River District Hospital, which employs about 221 workers for services including an emergency department and an obstetrics unit, has been financially struggling the past several years. In fiscal 2017 ended June 30, the hospital lost $4.8 million on net patient revenue of $82.9 million, according to American Hospital Directory, a Louisville-based consulting company, which bases its figures on Medicare cost reports. From 2013 through 2017, the hospital lost a total of $30.3 million on operations.

MacKenzie said River District's four-bed ICU was underused. The ICU accounted for about 5 percent of the hospital's 5,665 total patient days in 2017, AHD said, which suggests each bed was occupied less than 20 percent of the time. She said the hospital will maintain emergency, surgery and a smaller-scale medical-surgical and obstetric units as well as imaging services. More than 31 full-time equivalent employees were laid off at River District.

Ascension also moved the infusion center at Crittenton Hospital and Medical Center in Rochester Hills to its nearby cancer center at I-75 and Crooks Road in Troy. Ascension acquired Crittenton in October 2015.

Crittenton has laid off 11.5 full-time equivalent employees, 2.5 of whom were registered nurses, out of about 1,100 employees.

Crittenton has improved its finances immensely since joining Ascension. In fiscal 2017, the hospital reported operating income of $9.8 million after losing $4.7 million in 2016 and $83 million from 2013 to 2015. Net patient revenue in 2017 was $203.4 million.